Megalaa Rosemary, Perez Geovanny F, Kilaikode-Cheruveettara Sasikumar, Kotwal Nidhi, Rodriguez-Martinez Carlos E, Nino Gustavo
Division of Pulmonary and Sleep Medicine, Children's National Medical Center, Washington, District of Columbia, USA.
Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
J Investig Med. 2018 Jan;66(1):46-51. doi: 10.1136/jim-2017-000491. Epub 2017 Sep 24.
Viral respiratory infections are often grouped as a single respiratory syndrome named 'viral bronchiolitis', independently of the viral etiology or individual risk factors. Clinical trials and guidelines have used a more stringent definition of viral bronchiolitis, including only the first episode of wheezing in children less than 12 months of age without concomitant respiratory comorbidities. There is increasing evidence suggesting that this definition is not being followed by pediatric care providers, but it is unclear to what extent viral respiratory infections are currently misclassified as viral bronchiolitis using standard definitions. We conducted a retrospective analysis of hospitalized young children (≤3 years) due to viral respiratory infections. Bronchiolitis was defined as the first wheezing episode less than 12 months of age. Demographic variables and comorbidities were obtained by electronic medical record review. The study comprised a total of 513 hospitalizations (n=453). Viral bronchiolitis was diagnosed in 144 admissions (28.1%). Notably, we identified that the majority of children diagnosed with bronchiolitis (63%) were misclassified as they had prior episodes of wheezing. Many children with bronchiolitis misclassification had significant comorbidities, including prematurity (51%), neuromuscular conditions (9.8%), and congenital heart disease (9.8%). Misclassification of bronchiolitis is a common problem that may lead to inappropriate management of viral respiratory infections in young children. A comprehensive approach that takes into consideration viral etiology and individual risk factors may lead to a more accurate clinical assessment of this condition and would potentially prevent bronchiolitis misclassification.
病毒性呼吸道感染通常被归为一种名为“病毒性细支气管炎”的单一呼吸道综合征，而不考虑病毒病因或个体风险因素。临床试验和指南对病毒性细支气管炎采用了更严格的定义，仅包括12个月以下儿童首次出现喘息且无并发呼吸道疾病的情况。越来越多的证据表明，儿科护理人员并未遵循这一定义，但目前尚不清楚按照标准定义，病毒性呼吸道感染被误分类为病毒性细支气管炎的程度如何。我们对因病毒性呼吸道感染住院的幼儿（≤3岁）进行了回顾性分析。细支气管炎被定义为12个月以下首次出现喘息发作。通过电子病历审查获取人口统计学变量和合并症信息。该研究共纳入513例住院病例（n = 453）。144例入院病例（28.1%）被诊断为病毒性细支气管炎。值得注意的是，我们发现大多数被诊断为细支气管炎的儿童（63%）被误分类，因为他们之前有过喘息发作。许多细支气管炎分类错误的儿童有显著的合并症，包括早产（51%）、神经肌肉疾病（9.8%）和先天性心脏病（9.8%）。细支气管炎的分类错误是一个常见问题，可能导致对幼儿病毒性呼吸道感染的管理不当。一种综合考虑病毒病因和个体风险因素的方法可能会对这种情况进行更准确的临床评估，并有可能防止细支气管炎的分类错误。
